Plaintiff
William Emerick, proceeding pro se, filed a state
court breach of contract suit against Defendant Blue Cross
Blue Shield Anthem (“Anthem”)[1], alleging that
Anthem failed to reimburse him and his now-deceased wife for
her medical expenses in accordance with their joint health
insurance policy. [DE 6] Anthem removed the matter to this
Court based on federal question jurisdiction, alleging that
Emerick's policy is an employee welfare benefit policy
created pursuant to the Employee Retirement Income Security
Act of 1974 (“ERISA”), 29 U.S.C. § 1001,
et seq. [DE 1 ¶ 5] On December 22, 2017, Anthem
moved to dismiss Emerick's case under Fed.R.Civ.P.
12(b)(6). [DE 8] Emerick never responded.[2] For the reasons
stated herein, the Court will deny Anthem's motion to
dismiss.

BACKGROUND

Emerick
and his now-deceased wife were joint beneficiaries of an
employee welfare benefit policy created under ERISA. The
policy bars beneficiaries from taking legal action to recover
benefits any later than three years after the date the
relevant claims are required to be furnished to Anthem [DE
9-1 at 89], and beneficiaries must provide Anthem with notice
of claims within 90 days of receiving covered services.
Id. at 80. However, the policy also states that
beneficiaries “must exhaust the Plan's Member
Grievance and Appeal procedures before filing a lawsuit or
other legal action of any kind against [Anthem].”
Id. at 89.

Emerick
alleges that, between November 2011 and January 2012, he
incurred significant expenses related to the hospitalization
and treatment of his wife, who suffered from an unspecified
form of cancer and a broken spine. In total, these expenses
equaled $232, 000. They included fees for her stay at a
hospital in Tijuana, Mexico, transportation via air ambulance
to and from said hospital, doctors' fees, and medication
costs. Emerick alleges that he submitted a demand for
reimbursement of these expenses on March 13, 2012, and that
he and his wife made continuous demands for this
reimbursement up until September 2016. He states that Anthem
tendered a fractional reimbursement of $20, 000, but he does
not allege when that happened, nor whether or when he
exhausted any internal appeal processes.

STANDARD

In
reviewing a motion to dismiss for failure to state a claim
upon which relief can be granted under Federal Rule of Civil
Procedure 12(b)(6), the Court construes the complaint in the
light most favorable to the plaintiff, accepts the factual
allegations as true, and draws all reasonable inferences in
the plaintiff's favor. Reynolds v. CB Sports Bar,
Inc., 623 F.3d 1143, 1146 (7th Cir. 2010). A complaint
must contain only a “short and plain statement of the
claim showing that the pleader is entitled to relief.”
Fed.R.Civ.P. 8(a)(2). That statement must contain sufficient
factual matter, accepted as true, to state a claim for relief
that is plausible on its face, Ashcroft v. Iqbal,
556 U.S. 662, 678 (2009), and raise a right to relief above
the speculative level. Bell Atl. Corp. v. Twombly,
550 U.S. 544, 570 (2007). However, a plaintiff's claim
need only be plausible, not probable. Indep. Trust Corp.
v. Stewart Info. Servs. Corp., 665 F.3d 930, 935 (7th
Cir. 2012). Evaluating whether a plaintiff's claim is
sufficiently plausible to survive a motion to dismiss is
“‘a context-specific task that requires the
reviewing court to draw on its judicial experience and common
sense.'” McCauley v. City of Chicago, 671
F.3d 611, 616 (7th Cir. 2011) (quoting Iqbal, 556
U.S. at 678).

DISCUSSION

As a
preliminary matter, the Court notes that Anthem attached a
“true and accurate copy” of the relevant employee
welfare benefit policy to its motion. [DE 9 at 2; 9-1] A
court normally cannot consider documents outside the
complaint without converting it into a motion for summary
judgment. See Fed. R. Civ. P. 12(d); Tierney v.
Vahle, 304 F.3d 734, 738 (7th Cir. 2002). That being
said, a court can consider documents attached to a motion to
dismiss if they are: part of the pleadings referred to in the
plaintiff's complaint; central to his claim; and properly
authenticated (or authenticity is conceded). See Hecker
v. Deere & Co., 556 F.3d 575, 582 (7th Cir. 2009);
Tierney, 304 F.3d at 738-39; Wright v.
Associated Ins. Cos., 29 F.3d 1244, 1248 (7th Cir.
1994); Venture Assocs. Corp. v. Zenith Data Sys.
Corp., 987 F.2d 429, 431 (7th Cir. 1993). Here, the
health insurance policy is referenced in the complaint and is
central to Emerick's claim that Anthem failed to
reimburse his wife's medical expenses. In addition, the
attached policy is concededly authentic because Emerick has
not challenged its authenticity. See Hecker, 556
F.3d at 582-83 (upholding district court's consideration
of documents attached to a motion to dismiss where the
parties did not dispute the documents' authenticity).
Therefore, the Court's consideration of the policy here
does not convert the instant motion into one for summary
judgment. See 188 LLC v. Trinity Indus., Inc., 300
F.3d 730, 735 (7th Cir. 2002).

A.
ERISA's Preemption of Breach of Contract Claims

Moving
on to the substance of the motion to dismiss, Anthem argues
that, because the policy is created under and governed by
ERISA, Emerick's state law breach of contract claims are
preempted by federal law. State common law causes of action
asserting improper processing of a claim for benefits under
an employee benefit plan regulated by ERISA are preempted by
the statute. 29 U.S.C. § 1144(a); Pilot Life Ins.
Co. v. Dedeaux, 481 U.S. 41 (1987). Thus, Emerick's
claim that Anthem “failed and refused to reimburse
[him] for reasonable medical expenses he incurred”
should ordinarily be preempted.

However,
while labeled a “breach of contract” claim under
state law, Emerick's complaint adequately sets forth the
elements of an ERISA action under 29 U.S.C. §
1132(a)(1)(B), which allows a beneficiary to bring a civil
action in federal district court “to recover benefits
due to him under the terms of his plan, to enforce his rights
under the terms of the plan, or to clarify his rights to
future benefits under the terms of the plan.” First,
Emerick alleges that he is a beneficiary[3] under the policy:
“Plaintiff … jointly with his deceased wife
… entered into a written health insurance contract
with the Defendant” and “Defendant …
contracted with the Plaintiff to provide coverage for the
medical needs of Plaintiff's decedent.” [DE 6 at 1]
Second, he clearly seeks to recover benefits he believes are
due to him under this policy. See generally, Id.
Because of this, the Court will not dismiss his case simply
because he names “breach of contract” as a claim
for relief but articulates a cause of action under ERISA.
See Bartholet v. Reishauer A.G. (Zurich), 953 F.2d
1073, 1078 (7th Cir. 1992) (explaining that identifying an
incorrect legal theory is not fatal where plaintiff brought
state breach of contract claim that was actually based on
ERISA); see also Johnson v. City of Shelby, 135
S.Ct. 346 (2014) (“Federal pleading rules call for
‘a short and plain statement of the claim showing that
the pleader is entitled to relief'; they do not
countenance dismissal of a complaint for imperfect statement
of the legal theory supporting the claim asserted.”)
(citation omitted).

B.
Timeliness

Preemption
arguments aside, Anthem also argues that Emerick's
lawsuit, initiated on November 1, 2017, should be dismissed
because he filed his complaint well after the contractual
limitation period lapsed. The policy's language mandated
that any legal action to recover benefits be taken no later
than three years after the date the claim was required to be
furnished to Anthem (ninety days after covered services
rendered). [DE 9-1 at 80, 89] Emerick alleges he incurred
medical expenses between November 2011 and January 2012 for
his wife's treatment. Thus, Anthem contends that the
policy's language limited him to taking legal action no
later than April 2015 (approximately ninety days plus three
years). But Anthem neglects to mention another provision in
the policy, which is required by ERISA itself, 29 U.S.C.
§ ...

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